Is Cerclage Height Associated with the Incidence of Preterm Birth in Women with a History-Indicated Cerclage?

ABSTRACT

This study was performed to determine if cerclage height is associated with spontaneous preterm birth in patients with a history-indicated cerclage. We performed a retrospective cohort study of women with a history-indicated cerclage. Functional cervical length and the cerclage height (distance from cerclage to the external cervical os) were obtained. The cohort was grouped into thirds, based on cerclage height percentile. Our primary outcome was spontaneous preterm birth <35 weeks. There were 21 women in group 1 (cerclage height <10 mm), 53 in group 2 (cerclage height 10 to 19 mm), and 31 in group 3 (cerclage height ≥20 mm). The rates of spontaneous preterm birth <35 weeks were similar between each group: 24, 17, and 10%, respectively (p = 0.38). Cerclage height is not associated with a reduction in spontaneous preterm birth for women with a history-indicated cerclage. The association between longer cerclage height and decrease in preterm birth was nonsignificant possibly due to the small sample size.

KEYWORDS

Cervical length - preterm birth - cerclage

REFERENCES

• 1 Easterday C L, Reid D E. The incompetent cervix in repetitive abortion and premature labor.  N Engl J Med. 1959;  260 687-690
• 2 Shirodkar V N. A new method of operative treatment for habitual abortions in the second trimester of pregnancy.  Antiseptic. 1955;  52 299-300
• 3 McDonald I A. Suture of the cervix for inevitable miscarriage.  J Obstet Gynaecol Br Emp. 1957;  64 346-350
• 4 Berghella V, Seibel-Seamon J. Contemporary use of cervical cerclage.  Clin Obstet Gynecol. 2007;  50 468-477
• 5 Lazar P, Gueguen S, Dreyfus J, Renaud R, Pontonnier G, Papiernik E. Multicentred controlled trial of cervical cerclage in women at moderate risk of preterm delivery.  Br J Obstet Gynaecol. 1984;  91 731-735
• 6 Rush R W, Isaacs S, McPherson K, Jones L, Chalmers I, Grant A. A randomized controlled trial of cervical cerclage in women at high risk of spontaneous preterm delivery.  Br J Obstet Gynaecol. 1984;  91 724-730
• 7 Althuisius S M, Dekker G A, van Geijn H P, Bekedam D J, Hummel P. Cervical incompetence prevention randomized cerclage trial (CIPRACT): study design and preliminary results.  Am J Obstet Gynecol. 2000;  183 823-829
• 8 MRC/RCOG Working Party on Cervical Cerclage . Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists multicentre randomised trial of cervical cerclage.  Br J Obstet Gynaecol. 1993;  100 516-523
• 9 Quinn M J. Vaginal ultrasound and cervical cerclage: a prospective study.  Ultrasound Obstet Gynecol. 1992;  2 410-416
• 10 Andersen H F, Karimi A, Sakala E P, Kalugdan R. Prediction of cervical cerclage outcome by endovaginal ultrasonography.  Am J Obstet Gynecol. 1994;  171 1102-1106
• 11 Rust O A, Atlas R O, Meyn J, Wells M, Kimmel S. Does cerclage location influence perinatal outcome?.  Am J Obstet Gynecol. 2003;  189 1688-1691
• 12 Guzman E R, Houlihan C, Vintzileos A, Ivan J, Benito C, Kappy K. The significance of transvaginal ultrasonographic evaluation of the cervix in women treated with emergency cerclage.  Am J Obstet Gynecol. 1996;  175 471-476
• 13 Dijkstra K, Funai E F, O'Neill L, Rebarber A, Paidas M J, Young B K. Change in cervical length after cerclage as a predictor of preterm delivery.  Obstet Gynecol. 2000;  96 346-350
• 14 Althuisius S M, Dekker G A, van Geijn H P, Hummel P. The effect of therapeutic McDonald cerclage on cervical length as assessed by transvaginal ultrasonography.  Am J Obstet Gynecol. 1999;  180 (2 Pt 1) 366-369
• 15 Funai E F, Paidas M J, Rebarber A, O'Neill L, Rosen T J, Young B K. Change in cervical length after prophylactic cerclage.  Obstet Gynecol. 1999;  94 117-119
• 16 Davis G, Berghella V, Talucci M, Wapner R J. Patients with a prior failed transvaginal cerclage: a comparison of obstetric outcomes with either transabdominal or transvaginal cerclage.  Am J Obstet Gynecol. 2000;  183 836-839
• 17 Lotgering F K. Clinical aspects of cervical insufficiency.  BMC Pregnancy Childbirth. 2007;  7 (Suppl 1) S17
• 18 Scheib S, Visintine J F, Miroshnichenko G, Harvey C, Rychlak K, Berghella V. Is cerclage height associated with the incidence of preterm birth in women with an ultrasound-indicated cerclage?.  Am J Obstet Gynecol. 2009;  200 e12-e15
• 19 O'Brien J M, Hill A L, Barton J R. Funneling to the stitch: an informative ultrasonographic finding after cervical cerclage.  Ultrasound Obstet Gynecol. 2002;  20 252-255